Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | AC 6681 | CA |
Y | 207Q00000X | Family Doctor | AC 6681 | CA |
N | 213E00000X | Podiatrist | AC 6681 | CA |
N | 222Z00000X | Podiatrist | AC 6681 | CA |
NPI | 1700176344 |
---|---|
Provider Name | Prof. Dan Xie |
First Address | Diamond Bar, CA 91765-1885 |
Second Address | Fullerton, CA 92832-2020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2011 |
Last Update Date | 16/04/2011 |